Urine Infection (cont.)

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

What causes a urinary tract infection (UTI)?

The most common causes of UTI infections are E. coli bacterial strains that usually inhabit the colon. However, many other bacteria can occasionally cause an infection. In addition, yeasts and some parasites may cause UTIs. In the U.S., most infections are due to Gram-negative bacteria with E. coli causing the majority of infections.

What are urinary tract infection (UTI) risk factors?

There are many risk factors for UTIs. In general, any interruption or impedance of the usual flow of urine (about 50 cc per hour in normal adults) is a risk factor for a UTI. For example, kidney stones, urethral strictures, an enlarged prostate, or any anatomical abnormalities in the urinary tract increases infection risk. This is due in part to the flushing or washout effect of flowing urine; in effect, the pathogens have to "go against flow" because the majority of pathogens enter through the urethra and have to go retrograde (against a barrier of urine flow in the urinary tract) to reach the bladder, ureters, and eventually the kidneys. Many investigators suggest that women are far more susceptible than men to UTIs because their urethra is short and its exit (or entry for pathogens) is close to the anus and vagina, which can be sources of pathogens.

People who require catheters have an increased risk (about 30% of patients with indwelling catheters get UTIs) as the catheter has none of the protective immune systems to eliminate bacteria and offers a direct connection to the bladder. Catheters that are designed to reduce the incidence of catheter-related infections are available (they incorporate antibacterial substances into the catheter that suppress bacterial growth), but are not used by many clinicians because of short-termed effectiveness, cost, and concern about antibiotic resistance development in bacteria.

There are reports that suggest that women who use a diaphragm or who have partners that use condoms with spermicidal foam are at increased risk for UTIs. In addition, females who become sexually active seem to have a higher risk of UTI. The term, “honeymoon cystitis,” is sometimes applied to a UTI acquired either during the first sexual encounter or a UTI after a short interval of frequent sexual activity.

Men over the age of 60 have a higher risk for UTIs because many men at or above that age develop enlarged prostates that may cause slow and incomplete bladder emptying. In addition, older males and female populations have seen recent rises in STDs; this increase is thought to be due to this group not using condoms as frequently as younger age groups.

Occasionally, people with bacteremia (bacteria in the bloodstream) have the infecting bacteria lodge in the kidney; this is termed hematogenous spread. Similarly, people with infected areas that are connected to the urinary tract (for example, prostate, epididymis, or fistulas) are more likely to get a UTI. Additionally, patients who undergo urologic surgery also have an increased risk of UTIs. Pregnancy does not apparently increase the risk of UTIs according to some clinicians; others think there is an increased risk between weeks six through 26 of the pregnancy. However, most agree that if UTIs occur in pregnancy, the risk of the UTI progressing in seriousness to pyelonephritis is increased, according to several investigators. In addition, their baby may be premature and have a low birth weight. Patients with chronic diseases such as diabetics or those who are immunosuppressed (HIV or cancer patients) also are at higher risk for UTIs.